How Much Responsibility Do I Bear? How Much Can I Bear?

I muse upon responsibility and bipolar disorder almost daily, but its been on my mind almost continually since I attended a Depression and Bipolar Alliance support group a week ago. A young man who was coming off of a long stretch of mania gave a little speech about how he is always responsible for his actions, and he “will not use [his] bipolar disorder as an excuse or a crutch.”

Some of the older members of the group exchanged glances — I was among the culprits — as if to say, “He’ll learn, and learn the hard way.” Because it is hard, very hard, for bipolar people to act responsibly, and can be devastating to have to take responsibility for one’s actions.

Before plunging into a detailed discussion, though, I’d like to define my terms.

First, there is acting responsibly — that is, deliberately, with care, and using all of the judgment and wisdom at one’s disposal. Responsible actions may become habits, but often — probably daily — we make choices that require the active exercise of responsibility.

For me, it is very different to take responsibility. For the purposes of this article, at least, taking responsibility means owning up to bad behavior and making amends to the greatest extent possible.

For me, the phrase being responsible contains both of these neatly. That said, I would like to meditate a bit on bipolar disorder and the vexed question of responsibility.

We older people gave wry and patronizing smiles because we know all too well that at times bipolar people will act irresponsibly — it’s not realistic, and it might be self-abusive, for that young man to believe that he will always be able to act calmly and self-reflexively, and to make wise decisions.

Just as depression is a disease of the will, manic depression impairs judgment. Poor judgment is a diagnostic criterion of mania in particular. By its very nature, then, bipolar disorder involves periodic loss of judgment. The unfortunate fact is that episodes can last months or years, and during that time the manic depressive will have little control over both her social behavior and her ability to care for herself or fight her disease. She may believe that she’s not ill and resist treatment, or she may be too exhausted and depressed to negotiate the mental health system. She cannot be held responsible during that time because she simply cannot behave responsibly. For both manic depressives and caretakers, that lesson is the resignation half of revolt and resignation.

However, that doesn’t mean that bipolar people can’t take responsibility at times for their bad behavior, and, perhaps more importantly, for their recovery. What caretakers need from us is not just for us to refrain from behaving badly and to comport ourselves as if we were sane — they need us to become as well as we can possibly be, so that we will be able to act responsibly more often, thus decreasing the terrible burden that we unintentionally impose upon others. Our loved ones’ most desperate wish is that our health improve. We’re obliged, therefore, for own sake and for others’, to take responsibility whenever we are able.

One way to begin, ironically, is to decide to remove some choices from our lives, and to hand over responsibility to others. Structuring our finances so that we can’t go broke is one important step which I discussed in a previous post. I am working on this partly because I just bought a house and dread losing it, but also because I have often relied on people financially, and I would like to be in a position to help them if they should ever need it. For people whose situations are less privileged, who are, for example, on SSI, it may be necessary to designate another person to receive their checks and provide an “allowance.” In my opinion, married bipolar people should consider arranging their finances so it’s impossible for them to make a purchase over a certain dollar amount without their spouse’s agreement.

Another positive example of handing over responsibility is writing an emergency plan and giving it to everyone to whom you are genuinely close, and whom you see often. (I couldn’t find a good template on the fly, so I’ll try to provide my own in the next post.) You need to trust a few people — perhaps two or three — to decide when you need to be hospitalized. You need to let them know that they have your permission to make wise decisions about your care when you can’t. This takes an incredible amount of faith and trust, but it could save your life. You should also ask a few close associates to take you aside and express their concern if they see you exhibiting certain symptoms. In this way, it might be possible to catch an episode while you can still see the necessity of calling your doctor for a med check.

So, yes, giving up certain freedoms is a part of acting responsibly. Educating yourself is another. Two more are maintaining hope and resilience. You must always be willing to fight to the extent that you are able. As a friend of mine once said, if you can improve your mood by even 10%, it’s your duty to do so. Note that he didn’t say that it’s an option, a nice thing, or just in your best interest. It is your duty.

This came back to me yesterday during a wide-ranging conversation with my parents. My dad expressed his existentially influenced philosophy as follows (I’m paraphrasing, of course — I don’t take notes during dinner table discussions): “I believe that we’re born alone and we die alone, and that our life’s work is to make connections with others. It’s nice if you can help other people, but your first responsibility is always to yourself, because if you don’t take responsibility for yourself, you won’t just be unable to help other people — you’ll be a burden on them.”

And that’s the dilemma of being bipolar: we have a duty to take responsibility, but we are often unable to act responsibly. It’s a nasty knot, that problem, one that we pick at constantly, and one that we need to unravel for ourselves.

I came close to undoing it with an Alexandrian stroke this morning on the way to church, actually. I thought, Wait a minute — sane people aren’t perfect. They make mistakes, sin, act badly and stupidly, and burden others. They may do it less often and to a lesser extent, but sane people aren’t saints. They behave without thinking, and sometimes aren’t capable of acting responsibly. We’re all human, we all err, and we all have a duty to do our best. Bipolar people face an intensified, purified version of this simple bit of the human condition.

Revolt and Resignation

In his collection of essays On Aging, Holocaust survivor Jean Amery said that one must meet the phenomenon of aging -- inevitable yet terrifying -- with both revolt and resignation. So it is with mental illness. To deny that I will always be manic-depressive would be true madness; at the same time, I must revolt against my condition, rejecting the idea that it defines and limits me.